Preventing kidney injury among sugarcane workers: Promising evidence from enhanced workplace interventions

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title = "Preventing kidney injury among sugarcane workers: Promising evidence from enhanced workplace interventions",
abstract = "Objectives: To assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin. Methods: Based on our findings during the 2017-2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018-2019 harvest (harvest 2). Actual work conditions during harvest 2 were then observed. Serum creatinine (SCr) was measured before and at end-harvest, and cross-harvest changes in estimated glomerular filtration rate (eGFR) and incident kidney injury (IKI, ie, SCr increase by ≥0.30 mg/dL or ≥1.5 times the baseline value) were compared between harvest 1 and harvest 2 for three jobs with different physical workloads using regression modelling. Workers who left during harvest were contacted at home, to address the healthy worker selection effect. Results: In burned cane cutters, mean cross-harvest eGFR decreased 6 mL/min/1.73 m2 (95{\%} CI 2 to 9 mL/min/1.73 m2) less and IKI was 70{\%} (95{\%} CI 90{\%} to 50{\%}) lower in harvest 2 as compared with harvest 1 data. No such improvements were seen among seed cutters groups with less successful intervention implementation. Conclusion: Kidney injury risk was again elevated in workers with strenuous jobs. The results support further efforts to prevent kidney injury among sugarcane workers, and other heat-stressed workers, by improving access to water, rest and shade. The distinction between design and implementation of such interventions should be recognised.",
keywords = "climate, international occupational health, intervention studies, renal, workload",
author = "Jason Glaser and Erik Hansson and Ilana Weiss and Catharina Wesseling and Kristina Jakobsson and Ulf Ekstr{\"o}m and Jenny Apelqvist and Rebekah Lucas and {Arias Monge}, Esteban and Sandra Peraza and Christer Hogstedt and Wegman, {David H.}",
year = "2020",
month = "5",
day = "13",
doi = "10.1136/oemed-2020-106406",
language = "English",
journal = "Occupational and Environmental Medicine",
issn = "1470-7926",
publisher = "BMJ Publishing Group",